2020-21 Medicare Spotlight - A Simple Introduction to Medicare What's Medicare? - Dutchess County ...
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A Publication of the Dutchess County Office for the Aging
2020-21 Medicare Spotlight
A Simple Introduction A Message From County
Executive Marc Molinaro
to Medicare
Friends,
What’s Medicare?
If you’ve been with Medicare for many years, it’s
Medicare is the Federal government program that possible that you may be happy with your current
provides health insurance coverage when you are coverage - but it’s also possible for features of
65 years of age or older - or under age 65 if you
your coverage to change from year to year. If
receive Social Security Disability. To be eligible
you’re new to Medicare this year, there’s a lot of
for Medicare, you must be a legal resident of the
potentially unfamiliar information to digest. Those
United States.
are the two key reasons why the Office for the
Aging provides this Medicare Spotlight, timed to
I’m turning 65, so what do I do?
coincide with Medicare’s annual open enrollment
There’s a seven-month window, which includes period of October 15th to December 7th.
the month of your 65th birthday, where you must
sign up for Medicare. The seven months consist After you’ve read this Spotlight, make the Office
of the month of your birthday, and the three for the Aging a key resource for following up on
months both before and after it. It’s called the issues specific to your coverage, with free and
Initial Enrollment Period. For example, if your 65th unbiased information from trained counselors.
birthday is March 8th, 2021, your Initial Enrollment
Period covers any month from December 2020 This year, making sure your coverage is right for
through June 2021. Having completed your you is more important than ever.
signup, Medicare coverage begins from one to
three months later. Sincerely,
Do I have to sign up for it when I turn 65?
Marc Molinaro
Yes - with one exception: If you or your spouse Dutchess County Executive
are still actively employed when you turn 65,
you can stay with your employer-provided group
coverage. That’s the only exception.
What’s inside
How does Social Security tie in with Medicare?
Introduction to Medicare..............................Pgs. 1-2
If you claimed Social Security benefits before
your 65th birthday, enrollment in Medicare Part A Medicare and Coronavirus................................Pg. 3
(hospitalization) and Part B (outpatient services) 2020-21 Medicare Timetable (clip-and-save)....Pg. 3
will be automatic. For the person in the example
Medicare and Seniors’ Flu Shots......................Pg. 4
above, their Medicare card would arrive in March
2021 and coverage would begin on March 1st. Medicare Workshops with Social Distancing.....Pg. 4
My Plan Is Ending - What Do I Do?...................Pg. 5
If you are not receiving Social Security and wish
Medicare’s “Donut Hole”....................................Pg. 6
to use Medicare benefits, you must notify Social
Security that you want Medicare. Avoid Unexpected Bills......................................Pg. 7
More on Page 2PAGE 2 2020-21 Medicare Spotlight | www.dutchessny.gov/aging
with coverage not beginning until July 1 of that
Introduction to year. Miss a General Enrollment deadline, and
you could be without Medicare for an extra year.
Medicare (continued)
What do I pay for Medicare?
I don’t want to apply for Social Security just yet Chances are you’ve been paying into the system
through much of your adult life, and that will cover
In that case, you’ll have some additional some costs.
responsibilities. You will still have the seven-month
Initial Enrollment Period around your 65th birthday, Medicare Part A is free for those who have
as noted previously. It is strongly suggested that you worked 40 Social Security quarters, or 10 years.
enroll in Medicare during that window - because if There’s a monthly Part A premium for those who
you miss it, you will end up paying penalties that will have worked up to 39 quarters.
continue for the rest of your life.
Medicare Part B has a monthly premium, the cost
For every 12 months you delay signing up for of which is determined each year.
Medicare after the Initial Enrollment Period, you
will pay a late enrollment surcharge that comes to Where can I use Medicare?
10% of the standard Part B premium for Part B, and
1% for every month you delay signing up for Part As long as the service you receive is a Medicare-
D (12% per year). You could be without key health covered service and your health care provider
care coverage if you miss the Initial Enrollment has not “opted out” of Medicare, you are covered
Period. It’s a risk you don’t need to take, on top of to go to almost any doctor or hospital in the
the financial penalties. country under Original Medicare. The Center for
Medicare and Medicaid Services (CMS) is the
I’ve heard about Part A, Part B and so forth federal agency that oversees Medicare.
Medicare has four different parts: Open Enrollment (October 15th-December 7th)
• Part A covers inpatient hospital services;
• Part B covers outpatient services; Medicare’s Annual “Open Enrollment” Period
• Part C includes Medicare Advantage starts on October 15th every year. Even if you’re
Plans; and happy with your current coverage, it’s a good
• Part D is Prescription Drug Plans. idea to learn whether it will continue to meet your
needs in 2020 and beyond. The Office for the
Unless you make another choice about how to Aging can help you examine your options.
get your benefits when you become eligible for
Medicare, you will have Original Medicare, the The opportunity to enroll in Medicare coverage to
traditional fee-for-service program. begin on January 1st, 2021 ends on December
7th, 2020.
I want to work until I’m 70, and then retire
I want to find out more - a lot more
For people in your situation, there’s a Special
Enrollment Period. It begins when your other The federal government’s annual Medicare and
insurance ends and lasts for eight months. Medicare You publication is sent to Medicare beneficiaries
coverage begins the month after you enroll. This is every September. To be sure your unique
another deadline that’s essential not to miss. Miss coverage needs are met, we recommend getting
the Special Enrollment Period, and you’ll have to in touch with a volunteer OFA counselor from
wait until Medicare’s General Enrollment Period - our HIICAP - the Health Insurance Information,
and yet another deadline. The General Enrollment Counseling and Assistance Program. Contact
Period is January 1st to March 31st of every year, OFA to find out more.2020-21 Medicare Spotlight | www.dutchessny.gov/aging PAGE 3
Medicare and Coronavirus 2020-21 Medicare
Timetable (Clip and save)
The first question that comes up when Dutchess
County seniors ask about Medicare as it relates to
the COVID-19/coronavirus is a simple one: What’s October 1st - 14th - Get ready for open
covered? enrollment. Take a look at what might change
with your current coverage. During these
As of October 2020, here’s what we know for sure: two weeks, private insurers will announce all
benefit and premium information for their Part
• Medicare covers the lab tests for COVID-19. You C Medicare Advantage and Part D Prescription
pay no out-of-pocket costs. Drug plans for 2021.
• Medicare covers FDA-authorized COVID-19 October 15th - December 7th - Open
antibody (or “serology”) tests if you were diagnosed enrollment. Any changes you make take effect
with a known current or known prior COVID-19 on January 1st, 2021.
infection or suspected current or suspected past
COVID-19 infection. January 1st - February 14th, 2021 - Annual
Disenrollment Period. This is the period
• Medicare covers all medically necessary when you can disenroll from a Part C Medicare
hospitalizations. This includes if you’re diagnosed Advantage plan and return to Original Medicare.
with COVID-19 and might otherwise have been If that’s your choice, you are allowed to choose a
discharged from the hospital after an inpatient separate Medicare prescription drug plan at the
stay, but instead you need to stay in the hospital same time. Any such plan becomes effective the
under quarantine. You’ll still pay for any hospital first of the following month.
deductibles, copays, or coinsurances that apply.
Contact us with your questions:
• As of when this newsletter was printed, there was (845) 486-2555 or ofa@dutchessny.gov
no vaccine for COVID-19. However, it will be covered
if/when one becomes available.
• If you have a Medicare Advantage Plan, you have 2020-21 Medicare Spotlight
access to these same benefits. Medicare allows
these plans to waive cost-sharing for COVID-19 lab Marcus J. Molinaro — County Executive
tests. Many plans offer additional telehealth benefits Todd N. Tancredi — Director, Office for the Aging
Brian Jones — Editor
and expanded benefits, like meal delivery or medical
transport services. Check with your plan about your Dutchess County Office for the Aging
coverage and costs. 114 Delafield St., Poughkeepsie NY 12601
And there are always scams to watch out for (845) 486-2555 / toll free (866) 486-2555
Email: ofa@dutchessny.gov
Scammers may use the coronavirus national
emergency to take advantage of people while they’re Available for free at libraries, senior centers and municipal
distracted. As always, guard your Medicare card buildings throughout Dutchess County,
like a credit card, check Medicare claims summary as well as at the OFA website:
forms for errors, and if someone calls asking for www.dutchessny.gov/aging
your Medicare number, just hang up! Don’t push any
buttons or answer any questions. Simply hang up. To be added to or removed from our mailing list,
call (845) 486-2544 or email bjones@dutchessny.gov.PAGE 4 2020-21 Medicare Spotlight | www.dutchessny.gov/aging
Medicare Covers Medicare Workshops
Seniors’ Flu Shots with Social Distancing
Getting your flu shot will be more important than OFA has been working with Adriance Memorial
ever this year. Be sure to take action against the Library in the City of Poughkeepsie (93 Market
flu and protect yourself and your loved ones by St.) and Boardman Road Library in the Town of
getting a flu shot. Poughkeepsie (141 Boardman Rd.) to hold a
series of socially distanced workshops focusing
Flu viruses change each year, so it’s important on the Medicare website. Reservations are
to get a flu shot each flu season. People with required for all workshops.
Medicare you pay nothing when you get your shot
each flu season from a doctor or another health Three daytime classes are scheduled for the
care provider (including pharmacies in New York) Adriance location, all at 9:30 a.m.:
that accepts Medicare.
Wednesday, October 28th
You can take important measures to prevent the Wednesday, November 25th
flu, like: Wednesday, December 23rd
• Washing your hands For 2021, classes will continue at Adriance on the
• Covering your nose and mouth when you cough fourth Wednesday of every month. The entrance
or sneeze to the library’s free parking lot is around the
• Staying home when you’re sick corner on Noxon Street.
• Cleaning frequently touched surfaces
Two evening classes are also on the schedule,
If those tips look familiar, they should. They’re the both from 6:30 to 8:30 p.m. Locations are in
same precautions you’d take to protect yourself parentheses.
from other diseases, including coronavirus,
noroviruses (those are the viruses that cause Tuesday, October 27th (Boardman)
gastroenteritis, also known by the misnomer Wednesday, November 18th (Adriance)
“stomach flu”), and countless other viral and
bacterial disorders. There’s a limit of six people per class due to
social distancing needs. Every attendee must
Not only will a flu shot help keep you and your wear a face covering and use hand sanitizer
family healthy, it can help reduce the strain on our before and after using classroom computers. All
healthcare system and keep hospital beds and class times and venues are subject to change
other medical resources available for people with based on the possibility of changing COVID
COVID-19. restrictions.
With two dangerous viruses going around at Reserve your seat by contacting OFA.
once, it’s time for us to protect our communities
by getting the vaccine we already have: the flu Report Medicare Fraud Attempts
vaccine. A flu shot won’t protect you against
COVID-19, but it has many other important 1-800-MEDICARE (633-4227)
benefits. including the reduction in the risk of flu
illness, hospitalization, and death. TTY: 877-486-2048
Visit CDC.gov for more information on how to Medicare will not contact you unless you
safely get a flu shot during the pandemic. contacted them first.2020-21 Medicare Spotlight | www.dutchessny.gov/aging PAGE 5
My Plan Is Ending - • Changes you make during January take effect
February 1st. Since your plan will have ended as of
What Do I Do? December 31st, you will be automatically enrolled
in Original Medicare as of January 1st so that you
Those of you with Medicare Advantage or Part D still have coverage until you have made a formal
plans may have experienced the following scenario: decision.
A letter arrives in early October, saying your plan
will no longer be available after year’s end. • Changes you make in February take effect March
1st. The same automatic enrollment in Original
Now what? Medicare as of January 1st will take place, as
described above.
The Office for the Aging’s volunteer HIICAP
(Health Information, Insurance, Counseling and Other Special Enrollment Periods
Assistance Program) counselors can help you
with that question. Due to the pandemic they’re You can make changes to your Medicare
helping seniors remotely, providing confidential Advantage and Medicare prescription drug
and unbiased information to seniors with expiring coverage when certain events happen in your life,
Medicare Advantage or Part D plans, so that such as if you move or you lose other insurance
they can move forward into 2021 with the right coverage. These chances to make changes are
coverage. Get in touch with us at (845) 486-2555 also considered Special Enrollment Periods. Rules
or ofa@dutchessny.gov to make counseling about when you can make changes and the type
arrangements, and remember: Counseling of changes you can make are different for each
appointments fill up quickly. period.
The regular Medicare Open Enrollment Plan There are many other situations that can trigger a
takes place from October 15th to December 7th, Special Enrollment Period: if you have a chance
as discussed elsewhere in this Spotlight - but, as to get other coverage; if your plan changes its
someone with a plan that’s ending, you have a contract with Medicare; if you become eligible for
Special Enrollment Period that runs from December both Medicare and Medicaid; and more than we
8th through February 28th, 2021. You may want to have space for here.
take care of making adjustments quickly, because
of the following factors: Again, our trained HIICAP counselors can help you
get all this sorted out so you can make sure your
• Changes you make from December 8th through transitions go smoothly. Contact us at:
December 31st take effect January 1st, right after
your expiring plan is no longer in effect. (845) 486-2555 or ofa@dutchessny.govPAGE 6 2020-21 Medicare Spotlight | www.dutchessny.gov/aging
Medicare’s “Donut
Hole” The “Hole” Truth
There’s a coverage gap in many Medicare drug
Example Is there a Donut Hole?
plans. Officially it’s known as the Coverage Gap.
Unofficially, it’s called the “donut hole.” It’s a You are qualified for No donut hole - your
temporary limit on what the drug plan will cover Medicare Part D Extra drug costs stay the
for drugs, the third payment stage in Medicare Help same
Part D drug plans. Your Medicare Part D You won’t notice
plan has a fixed 25% entering the donut
But didn’t the donut hole close in 2020? cost-sharing hole because your
drug costs will stay
Mostly - but while the hole is closed, your out- the same
of-pocket costs continue. By the estimate of the
Your Medicare Part You may pay more (or
Centers for Medicare and Medicaid Services
D plan has different less) for drugs in the
(CMS), as of 2010 there were 8 million Medicare
co-pays for different donut hole
Part D beneficiaries affected by the donut hole.
formulary tiers
By 2016 the number was down to 5 million,
with discounts introduced in 2012. As of 2020,
discounts on all medications - now and in the
future - are 25%.
What could still put me in the donut hole?
Sometimes, just one or two recurring
HIICAP
(Health Insurance Information, Counseling
prescriptions for brand-name drugs could do it. and Assistance Program)
A person taking medications to treat certain rare
diseases can pass through the first three stages
- the third being the donut hole - in just a couple Dutchess County OFA’s volunteer
of months. The donut hole can become a regular HIICAP counselors provide free, unbiased
experience for these seniors, since what’s being information and help you learn about...
treated are often chronic conditions.
• Medicare and Medicaid •
Beyond the Donut Hole • Medigap Policies •
• Medicare Advantage Plans •
Should your 2021 out-of-pocket costs exceed • Long-Term Care Insurance •
$6,550, you’ll enter the Catastrophic Coverage • Low-Income Subsidy Programs •
component of Part D. In this stage, one will
pay the greater of 5% or $3.70 for generic ...and other health insurance programs
medications and $9.20 for brand-name drugs. available in Dutchess County.
(In 2020, those amounts were $3.60 and $8.95,
respectively.) There is no maximum amount or Call (845) 486-2555 to make your
cap on how much one will pay. appointment for remote counseling
If you’re worried this is becoming hard to follow,
you are not alone. Contact OFA for unbiased
NYS HIICAP hotline
counseling on the plans tailored to your needs for (800) 701-0501
2021.2020-21 Medicare Spotlight | www.dutchessny.gov/aging PAGE 7
Avoid Unexpected Bills
Know the Difference Between a Medicare Wellness Exam and a Physical
Annual Wellness Visit Annual Physical Exam
(Your Medicare deductible is waived) (The Part B deductible applies)
Cost: FREE Cost: Co-pay
Coverage: Annually, when it occurs at least 12 Coverage: Annually; you will be billed and
months after your Initial Preventative Physical responsible for 20% of the Medicare approved
Exam, and when you have been covered by Part amount
B for more than 12 months
Purpose: For medically necessary services,
Purpose: To develop and update a personalized including evaluation and management of an
prevention plan, based on your current health illness or injury
and risk factors
Other: Medications may be refilled or prescribed
Other: Medications are not refilled or prescribed
The terms “wellness exam” and “physical” sound similar, but when it comes to Medicare the
two procedures are not interchangeable. It’s something you’ll need to watch for when you make
appointments with your doctor. The wellness exam is different from a full body physical that you may
have undergone in past years.
If you’ve had Medicare Part B (Medical Insurance) for longer than 12 months, you can get a yearly
“Wellness” visit once every 12 months to develop or update a personalized prevention plan to help
prevent disease and disability, based on your current health and risk factors. Your provider may also
perform a cognitive impairment assessment. You pay nothing for this visit if your doctor or other qualified
health care provider accepts assignment - that is, they have agreed to accept the Medicare-approved
amount as full payment for any covered service provided to a Medicare patient.
The Part B deductible doesn’t apply. However, you may have to pay coinsurance, and the Part B
deductible may apply if:
• Your doctor or other health care provider performs additional tests or services during the same
visit. These additional tests or services aren’t covered under the preventive benefits.
• A cognitive impairment assessment is performed to look for signs of Alzheimer’s disease or
dementia.
The personalized prevention plan is designed to help prevent disease and disability based on your
current health and risk factors. Your provider will ask you to fill out a questionnaire, called a “Health Risk
Assessment,” as part of this visit. Answering these questions can help you and your provider develop a
personalized prevention plan to help you stay healthy.
Before your Medicare wellness visit, compile a complete list of medications that you take, as well as any
vitamins, minerals, supplements, and over-the-counter medications.Dutchess County Office for the Aging
114 Delafield Street, Poughkeepsie, NY 12601 PRESORTED
STANDARD
U.S. POSTAGE PAID
NEWBURGH, NY
PERMIT NO. 17
RETURN SERVICE REQUESTED
TO:
Friends,
Welcome to the fourth annual Medicare-focused version of our “Spotlight on Seniors”
newsletter. Medicare’s open enrollment period for coverage starting in January 2021 runs from
October 15th to December 7th, 2020. There’s a clip-and-save Medicare timetable on Page 3.
Medicare is designed to adapt to individuals’ unique health situations, but comparing plans and
features can become complicated. That’s why we encourage you to get in touch with the Office for the
Aging for free, unbiased counseling on the health issues that affect you specifically.
Our best wishes,
Marcus J. Molinaro Todd N. Tancredi
Dutchess County Executive Director, Office for the Aging
Dutchess County Office for the Aging • 114 Delafield St., Poughkeepsie NY 12601
(845) 486-2555 or (866) 486-2555 • email: ofa@dutchessny.gov • www.dutchessny.gov/agingYou can also read
